Progestin pill side effects (especially dizziness/spotting ) duration?

February 14, 2013 6:28 PM

I've been on a progestin-only pill to prevent pregnancy for three weeks, and I am unhappy. Wondering if anyone experienced similar symptoms, especially dizziness/hypotensive episodes and irregular bleeding) and how long they took to go away for you. (details within)

I am currently in the middle of treatment for a DVT in my lower calf (from an ankle fracture). That will hopefully be over in a month or so. However, due to this, when I went to get a new birth control prescription last month (I remained on my old pill for about 7 weeks post-DVT), they refused to give me my old combined pill and gave me a choice between this progestin pill and implant/IUDs. I don't want foreign objects inside my body, so I agreed to try the progestin pills.

From day one, I felt bloated and pre-menstrual. On day two, and daily ever since, I began to experience episodes of postural hypotension.

I am in my early 30s and dealing with postural hypotension since my teens (and been on hormonal birth control since age 24), but it had been mostly under control and episodes had become rare. The only recent change I've made has been this pill and now I get these episodes daily, sometimes multiple times. The insert says this pill can cause dizziness, so I've been hoping it will go away or lessen.

Today, I started spotting. I was always been extremely regular before birth control, and my experience on combined pills was the same, just slightly lighter. I find it makes me reassured to know I'm not pregnant and feel normal to have a period each month, even if it is a withdrawal bleed. So, one of the things I feared on progestin pills was spotting/irregular and/or absent bleeding. Probably my main concern.

More than anything, after this DVT stuff, I just want to feel normal. Like myself. Like my life and my choices are my own.

I've also seemingly gained three or four pounds. Without eating enough to do that. I'm overweight and trying to lose, so it was not fun to see my recent progress obliterated.

I'm trying to hold out until I am off the anticoagulants and return to a low-dose combined pill to give me the consistency I'm looking for, but that will take time and persistence.

Should I try to stick it out, even though I'm really unhappy right now, or do you think I should call a doctor? If you've had dizziness or spotting on progestin methods, how long did it take for you to get back to a regular monthly cycle? Ever?

posted by Fire to health & fitness (14 answers total)

My gynecologist told me that a significant percentage of her patients who switched to the progestin-only pill had, quote, "never-ending spotting." My own period has disappeared entirely on it (for more than a year now!) which, yay, but obviously that would upset some people. If you hate it, why not go back to a barrier method until it is safe for you to use a combined pill?
posted by charmedimsure at 6:44 PM on February 14 [2 favorites]

According to my handy references of drug side effects, all of things you are experiencing are probably side effects of the progesterone you are taking. Unfortunately, none of them say if the side effects subside or not.
Personally, I would go to the doctor and ask to be switched to something else or do as the previous post suggested and switch to a barrier method without a pill until you are able to use one that is right for you. That is what I did when my doctor changed my birth control to something that made me alternately angry and sobbing sad for the better part of three months. Or, you could go talk to a pharmacist, they would probably be able to give you good advice.
posted by Sucht at 9:46 PM on February 14

My doctor told me that the spotting could last for about three months. Personally I had one very brief episode and then nothing at all since. I have had a few episodes of dizziness now you come to mention it, but it sounds like yours is more of an issue.

At risk of raining on your fireworks, did you check with your doctor whether you will be allowed to have the combined pill again? The reason I'm no longer on my combined pill is because apparently having one migraine with aura ever now makes me too high risk to prescribe the combined pill to ever again.
posted by kadia_a at 11:00 PM on February 14

-I've been in this relationship for 8 years and we've never used barriers. I'm good with the pill so I find it easy and that's what we've relied on. It would be very strange and not really very spontaneous to use that stuff now.

-As far as being allowed to use combined pills, I've done my homework and as far as the WHO/Federal guidelines in the US go, there are risk categories from 1-4. Right now, being treated for acute DVT, I'm in category 4, which is essentially do not prescribe/discontinue. Once my treatment is over, I'll be in category 3, which is considered 'if the benefits outweigh the risks, then prescribing is okay with caution' It's generally a no, but with certain circumstances and patient wishes (I am totally willing to sign a waiver), it's much more doable.

I'm being treated in a local clinic since I don't have insurance, and I have to be my own advocate here. The doctor there, who I've seen all of once, wants me to stay off combined pills, Planned Parenthood was the place that limited my choice to progestin pill or IUD/implant. But I spoke to a higher up there, and she said that returning would be a possibility once I'm out of category 4.

And if anything, I can always go somewhere new and just not mention my history. And if I ever have any surgeries or any further leg trauma, just make sure to have them keepextra vigilant.
posted by Fire at 11:18 PM on February 14

I haven't had any noticeable side effects from progestin-only pills, except for my cycle going absolutely wacky. Two periods in a month, six weeks without, periods that start out normal but turn into 10+ days of spotting, you name it. I would say I've had mid-cycle spotting, but it's not like I know where my cycle is anymore. POPs are notorious for wreaking havoc with menstruation, and if you're lucky you will get to experience all the variations. But they're my only hormonal option thanks to my high blood pressure; otherwise you'd better believe I'd be on something less annoying. POPs tend not to be anyone's first choice.

I'd personally feel deeply uneasy about withholding information as major as a recent surgery for the sake of getting a pill that worked better for me. On the other hand, I've definitely had encounters with doctors where I felt like they didn't quite grasp my situation.

I'd recommend giving the POP another three to five weeks and see if things settle; sometimes side effects subside after a month or two. If you feel too awful to wait that long, and if you think you'll be cleared to use your normal pill in a few weeks/months, I'd say discontinue the pill and use a barrier method in the meantime. Yeah, it will feel weird and awkward after going without for eight years. But awkward and less-than-great sex is better than constantly feeling crappy.

If you can live with the side effects but really want that periodic assurance that you're not pregnant, order one of those cheap 50-packs of pregnancy test strips from Amazon and pee on one whenever you're feeling unsure.
posted by Metroid Baby at 5:33 AM on February 15 [1 favorite]

I'm on Micronor, have been for the better part of a year. I take it because I am scared of getting an IUD, and estrogen pills trigger migraines. My periods have been irregular since before the pill and they still are now, but now they come much farther apart. I track them on my phone and the average length of my cycle is 43 days. I skip periods alltogether sometimes too, which freaks me the hell out every time. I also spot pretty regularly, sometimes heavily. I just toss my DivaCup up there and it isn't a big deal. The DivaCup is awesome also for the irregular periods. I have no problem having it in if I think my period might start today, know what I mean? Tampons suuuuuuuuuck coming out if there hasn't been adequate, er, fluid... And I hate pads. DivaCup forevah!

But yeah, after a year I am still even more irregular than I was before I went on the minipill. Sorry.
posted by PuppetMcSockerson at 10:04 AM on February 15

He wouldn't be comfortable with condoms, so that's out and I don't want to be inserting anything or messing with spermicides or anything, so no barriers.

The combined pill always worked perfectly for me. I maintained regular, good cycles, didn't really have any side effects. My blood pressure was always healthy. It's really a great solution that I'd rather take the still small risk on than remain on something that makes me feel really uncomfortable and unhappy.

It seems like the chances of having regular, reliable cycles is rather low, so not sure this is worth the stress. I would rather not omit my history, but I also don't want my choice limited forever because I tripped and fell and needed some time to heal a bone.
posted by Fire at 12:18 PM on February 15

I'd like to add a couple random thoughts about IUD's, because I have one and love it.

One, you mentioned that you don't want an IUD because you don't want a foreign object in your body, and I very much emphasize with that. However, in my opinion, a non-hormonal, copper IUD is much less intrusive than a daily dose of synthetic hormones.

Two, in my own yet highly typical experience, progestin-only absolutely kills your sex drive. The worst part is that you don't notice; kind of like you don't notice the brain fog until you get some coffee in your system. Same goes for your hair and nails. Two weeks off the hormones, you will be upset you didn't do it sooner.

Obviously, only you can decide what is right for you. I just hope you at least consider Paragard (the only non-hormonal IUD on the market). For roughly $500, you get 10 years of worry-free, chemical-free contraception.

(For complete disclosure, it does hurt to install one. However the pain lasts several seconds, a small price to pay for getting your body back).
posted by rada at 3:38 PM on February 15

From all that I have heard about Paragard, it makes your periods long and heavy. And women report more/more severe cramps. I wouldn't want a longer, heavier, more painful period. Combination pills gave me the closest to my own natural cycle without side effects. And if I hate it, I can't just stop right off. They generally make you wait a bit before removal.
posted by Fire at 4:12 PM on February 15

Thanks for the responses. Last night, I was weeping uncontrollably and feeling inexplicably sad. I think a new method might be in serious order.
posted by Fire at 10:50 AM on February 16

Usually your provider is going to want you to wait 3 cycles (months) before giving up on a pill. It can take some time for your body to get used to it. This is normal and most women who stick with it find their side effects resolve.

Remember that progestin-only pills must be taken at the same time each day (seriously). It's not like the combo pills where if you miss one you can double up the next day. If you miss by more than 3 hrs you have to use barrier/abstinence for at least 2 days, lest you risk pregnancy.

Good luck!
posted by eldiem at 8:04 PM on February 16

I've been taking them within the same 10 minute window because the material that they gave me said taking them consistently can help prevent irregular bleeding. That obviously didn't work. And irregular bleeding is unacceptable to me, and it comes with so many other side effects that I can't last three months.
posted by Fire at 8:11 AM on February 17

Sorry, I know that it's frustrating. There are things unacceptable to you (irregular bleeding, barrier methods of contraception), and then there are things unacceptable to your doctor (increased risk of repeat DVT, pulmonary embolism, heart attack, stroke, and death). I really don't mean to minimize your concerns, because they're an important reason why you're taking oral contraceptives in the first place. I know once my blood pressure was too high so I couldn't get my prescription continued; the doc called me at work to tell me this and I cried at my desk. But the docs aren't being mean, they are just trying to help you not have any of those nasty things that estrogens can do to people predisposed to them. If the side effects of the progestin-only pill are too much for you, have you considered any more permanent birth control options?
posted by eldiem at 9:43 AM on February 17

I want children.

And I'm willing to accept the risks and do what it takes to let myself feel normal again. Because I've given this a try and I"m very unhappy. I am not predisposed to anything with regards to estrogens. I have been on way higher estrogen content methods like the patch (which retains up to over 60% more estrogen in the blood than pills) and risk of anything bad happening with estrogens decreases over time. I've been on combined pills for eight years. Risk is highest in the first year and then goes way down with the longer duration.

I broke an ankle and was subsequently immobile, which caused the clotting. I am also overweight, but working on that (though this pill has set me back a few weeks' time). That combination was enough. Totally healthy otherwise.

I have to be my own advocate here, over doctors I have seen all of once.
posted by Fire at 10:54 AM on February 17